MEDICARE: MS. IRMA FRANCES LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1851673719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRMA FRANCES LOPEZ

Provider Business Mailing Address
First Line	:	109 MCCARTHY AVE STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79915-3813
Country	:	US
Telephone Number	:	915-202-5420
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 MCCARTHY AVE STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79915-3813
Country	:	US
Telephone Number	:	915-202-5420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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